title: Associations with chest illness and mortality in chronic spinal cord injury.
abstract: OBJECTIVE
  Identify factors associated with chest illness and describe the relationship between chest illness and mortality in chronic spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional survey assessing chest illness and a prospective assessment of mortality.
  
  
  METHODS
  Between 1994 and 2005, 430 persons with chronic SCI (mean ± SD), 52.0 ± 14.9 years old, and ≥4 years post SCI (20.5 ± 12.5 years) underwent spirometry, completed a health questionnaire, and reported any chest illness resulting in time off work, indoors, or in bed in the preceding 3 years. Deaths through 2007 were identified. Outcome measures Logistic regression assessing relationships with chest illness at baseline and Cox regression assessing the relationship between chest illness and mortality.
  
  
  RESULTS
  Chest illness was reported by 139 persons (32.3%). Personal characteristics associated with chest illness were current smoking (odds ratio =2.15; 95% confidence interval =1.25-3.70 per each pack per day increase), chronic obstructive pulmonary disease (COPD) (3.52; 1.79-6.92), and heart disease (2.18; 1.14-4.16). Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30; 0.88-1.91). In a multivariable model, independent predictors of mortality were greater age, SCI level and completeness of injury, diabetes, a lower %-predicted forced expiratory volume in 1 second, heart disease, and smoking history. Adjusting for these covariates, the effect of a previous chest illness on mortality was attenuated (HR = 1.15; 0.77-1.73).
  
  
  CONCLUSIONS
  In chronic SCI, chest illness in the preceding 3 years was not an independent risk factor for mortality and was not associated with level and completeness of SCI, but was associated with current smoking, physician-diagnosed COPD, and heart disease history.
authors.forename: Valery A
authors.initials: VA
authors.lastname: Danilack
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Tun
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Morse
authors.forename: Eric
authors.initials: E
authors.lastname: Garshick
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000401:mortality*; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires
keywords: Mortality; Respiratory tract infections; Spinal cord injuries